Immediate- and controlled-release zolpidem ingestions reported to Texas poison centers

2009 ◽  
Vol 28 (8) ◽  
pp. 505-509 ◽  
Author(s):  
Mathias B Forrester
Keyword(s):  
Controlled Release ◽  
Care Facility ◽  
Health Care Facility ◽  
Immediate Release ◽  
Poison Control ◽  
Clinical Effects ◽  
Control Center ◽  
Poison Control Centers ◽  
Poison Centers ◽  
The Mean

Zolpidem is available in immediate-release (IR) and controlled-release (CR) formulations. This investigation examined whether there were differences in zolpidem IR and CR ingestions reported to poison control centers. Zolpidem ingestions that did not involve coingestants reported to Texas poison control centers during 2005-2008 were identified. The ingestions were grouped by IR and CR formulations and compared with respect to demographic and clinical factors. There were 734 IR and 163 CR ingestions. The mean dose ingested was 92.9 mg and 104.6 mg, respectively. IR and CR cases were, respectively, 56.9% and 58.3% male, 54.6% and 49.7% age >19 years, 65.0% and 65.0% already at or en route to a health care facility when the poison control center was contacted, and 30.1% and 39.3% involved no effect. The most frequently reported adverse clinical effects were, for IR and CR, respectively, drowsiness (54.4% vs 42.3%), tachycardia (10.6% vs 11.7%), ataxia (6.3% vs 11.7%), slurred speech (6.3% vs 6.7%), vomiting (5.0% vs 5.5%) and hallucinations/delusions (4.9% vs 3.1%). The distribution of zolpidem IR and CR ingestions reported to Texas poison control centers were similar. However, zolpidem CR ingestions appeared less likely to result in drowsiness and hallucinations but more likely to result in ataxia.

Pattern of ziprasidone exposures reported to Texas poison centers, 2001–2005

2008 ◽  
Vol 27 (4) ◽  
pp. 355-361 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Age Distribution ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Clinical Effects ◽  
Poison Control Centers ◽  
Poison Centers ◽  
The Mean

Information on potentially adverse exposures to the atypical antipsychotic drug ziprasidone is limited. This study described the pattern of exposures involving only ziprasidone (isolated exposures) reported to Texas poison control centers during 2001–2005. The mean dose was 666 mg. The patient age distribution was ≤5 years (11%), 6–19 years (30%), and ≥20 years (60%). The exposures were intentional in 53% of the cases. Seventy-five percent of the exposures were managed at health care facilities. The final medical outcome was classified as no effect for 39% of the cases and minor effects for 40% of the cases. Adverse clinical effects were listed for 53% of the patients; the most frequently reported being neurological (42%), cardiovascular (13%), and gastrointestinal (5%). The most frequently listed treatment was decontamination by charcoal (34%) or cathartic (28%). Potentially adverse ziprasidone exposures reported to poison control centers are likely to involve management at a health care facility and involve some sort of adverse clinical effect. With proper treatment, the outcomes of such exposures are generally favorable.

Adult glyburide ingestions reported to Texas poison control centers, 1998—2005

2007 ◽  
Vol 26 (7) ◽  
pp. 563-571 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Poison Control Center ◽  
Limited Information ◽  
Control Center ◽  
Poison Control Centers

Limited information exists on potentially adverse adult glyburide ingestions reported to poison control centers. Using adult glyburide ingestions reported to Texas poison control centers during 1998—2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 126 cases identified, 49 (39%) involved serious outcomes. Serious outcomes were significantly more likely to occur with a maximum dose > 24 mg (RR 4.74, 95% CI 1.74—14.90) or >4 tablets (RR 3.27, CI 1.57—7.31), where the circumstances of the exposures involved self-harm or malicious intent (RR 2.44, CI 1.33—4.46), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR 12.89, CI 4.00—66.12) or referred to a health care facility by the poison control center (RR 12.21, CI 3.53—65.01). The severity of the outcome associated with adult glyburide ingestions depended on the dose and the circumstances of the ingestion. The management of patients with severe outcomes was more likely to involve health care facilities. Such information is useful for creating triage guidelines for the management of adult glyburide ingestions. Human & Experimental Toxicology (2007) 26: 563—571.

Adult metaxalone ingestions reported to Texas poison control centers, 2000-2006

2009 ◽  
Vol 29 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Mathias B Forrester
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Minor Effect ◽  
Clinical Effects ◽  
Medical Outcome ◽  
Poison Control Centers ◽  
Few Data

Few data exist on potentially adverse metaxalone (Skelaxin®) ingestions in adults. All metaxalone ingestions involving patients aged ≥20 years during 2000-2006 were retrieved from Texas poison control centers. Exclusion criteria were lack of follow-up or multiple substance ingestion. Cases were analyzed for selected demographic and clinical factors. Of the 142 patients, 66.2% were female. Dose ingested was reported for 61 patients. Of those cases with a reported dose, distribution by management site was 29.5% on-site, 59.0% already at/en route to health care facility, and 11.5% referred to health care facility. Final medical outcome was ‘no effect’ for 50.8% cases, ‘minor effect’ for 31.1%, and ‘moderate effect’ for 18.0%. The more common adverse clinical effects reported were drowsiness (27.9%), tachycardia (6.6%), agitation (6.6%), nausea (4.9%), dizziness (4.9%), slurred speech (4.9%), and tremor (4.9%). A moderate medical outcome occurred in 13.6% of ingestions of ≤2400 mg and 20.5% of ingestions of >2400 mg. Management involved a health care facility in 18.2% of ingestions of ≤2400 mg and 100.0% of ingestions of >2400 mg. This study found that adult ingestions of higher doses of metaxalone, particularly >2400 mg, were associated with more serious medical outcomes and were managed at health care facilities. This study also proposes triage guidelines for when ingestions can be safely managed at home.

Adult lisinopril ingestions reported to Texas poison control centers, 1998—2005

2007 ◽  
Vol 26 (6) ◽  
pp. 483-489 ◽  
Author(s):  
Mathias B. Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Poison Control Center ◽  
Limited Information ◽  
Control Center ◽  
Poison Control Centers

There is limited information on potentially adverse lisinopril ingestions reported to poison control centers. Using adult lisinopril ingestions reported to Texas poison control centers during 1998—2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 468 cases identified, 43 (9%) involved serious outcomes. The severity of the outcome associated with adult lisinopril ingestions depended on the dose and the circumstances of the ingestion. Thus, serious outcomes were significantly more likely to occur with a maximum dose >80 mg (RR 5.69, CI 2.43—13.33) or, if the dose was unknown, ≥3 tablets (RR 9.57, CI 2.39—54.97), where the circumstances of the exposures involved self-harm or malicious intent (RR 6.96, CI 3.65—13.31), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR 7.33, CI 3.09—17.85) or referred to a health care facility by the poison control center (RR 23.76, CI 10.62—55.67). The management of patients with severe outcomes was more likely to involve health care facilities. Such information is useful for creating of triage guidelines for the management of adult lisinopril ingestions. Human & Experimental Toxicology (2007) 26, 483—489

Escitalopram ingestions reported to Texas poison control centers, 2002—2005

2007 ◽  
Vol 26 (6) ◽  
pp. 473-482 ◽  
Author(s):  
M.B. Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Poison Control Center ◽  
Limited Information ◽  
Control Center ◽  
Poison Control Centers

Limited information exists on potentially adverse escitalopram ingestions reported to poison control centers. Using isolated escitalopram ingestions reported to Texas poison control centers during 2002—2005, the proportion of cases involving serious medical outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 1179 cases identified, 234 (20%) involved serious outcomes. Serious outcomes were significantly more likely to occur with a maximum dose of >100 mg (RR 4.69, CI 2.52—9.29) or >5 tablets (RR 4.96, CI 2.94—8.93), where the circumstances of the exposures involved self-harm or malicious intent (RR 3.21, CI 2.42—4.29), or when the patient was already at or en route to a health care facility when the poison control center was contacted (RR 7.88, CI 4.31—15.79) or referred to a health care facility by the poison control center (RR 15.91, CI 8.78—31.64). The severity of the outcome associated with isolated escitalopram ingestions depended on the dose and the circumstances of the ingestion. The management of patients with serious outcomes were more likely to involve health care facilities. Such information is useful for creating triage guidelines for the management of escitalopram ingestions. Human & Experimental Toxicology (2007) 26 , 473—482

Adult metformin ingestions reported to Texas poison control centers, 2000–2006

2008 ◽  
Vol 27 (7) ◽  
pp. 575-583 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Poison Control ◽  
Medical Outcome ◽  
Limited Information ◽  
Poison Control Centers ◽  
Hypoglycemic Agent ◽  
The Mean

Metformin is an oral hypoglycemic agent used in the management of type 2 diabetes mellitus. Limited information exists on adult metformin ingestions reported to poison control centers. The distribution of adult metformin ingestions reported to Texas poison control centers during 2000–2006 was determined for various factors. In addition, triage guidelines for the management of isolated ingestions were drafted. Of 1528 total metformin ingestions, 58% involved coingestants. Of the 264 ingestions of metformin alone, where the final medical outcome was known, dose ingested was reported for 66%. The mean reported dose was 4739 mg (range 500–60,000 mg). Ingestions of ≤2500 mg and >5000 mg reported doses differed with respect to the proportion involving suspected attempted suicide (6% versus 81%), serious final medical outcome (3% versus 19%), and referral to a health care facility (3% versus 83%). Using 5000 mg as a threshold dose for referral to a health care facility, 91% of cases not already at or en route to a health care facility were managed according drafted triage guidelines.

Comparison of Immediate-Release and Controlled-Release Paroxetine Ingestions Reported to Texas Poison Control Centers between 2002 and 2008

2009 ◽  
Vol 25 (3) ◽  
pp. 169-175
Author(s):  
Mathias B Forrester
Keyword(s):  
Controlled Release ◽  
Immediate Release ◽  
Healthcare Facility ◽  
Poison Control ◽  
Medical Outcome ◽  
Limited Information ◽  
Medical Outcomes ◽  
Control Center ◽  
Poison Control Centers ◽  
Therapeutic Benefits

Background: Controlled-release (CR) paroxetine was created to improve the tolerability of immediate-release (IR) paroxetine while maintaining therapeutic benefits. There is limited information comparing the toxicity of the 2 paroxetine formulations. Objective: To compare the toxicity and management of paroxetine IR and paroxetine CR ingestions reported to poison control centers. Methods: Cases of ingestion of paroxetine that were reported to Texas poison control centers between 2002 and 2008, in which the final medical outcome and dose were known, were retrospectively reviewed. The rates for selected variables were determined for paroxetine IR and paroxetine CR and comparisons between the 2 were made by calculating the ratio of the drug's CR rate to the IR rate and 95% confidence interval. Compliance with simplified algorithms of triage management guidelines was determined for both formulations. Results: Included in the analysis were 405 cases of paroxetine IR ingestion and 169 cases of paroxetine CR ingestion for which a reported dose and final medical outcome were known. There were no statistically significant differences between the paroxetine CR and paroxetine IR formulations with respect to serious medical outcomes (ratio 0.69, 95% CI 0.34 to 1.31), self-harm or malicious intent (ratio 0.82, 95% CI 0.60 to 1.12), or referral to a healthcare facility (ratio 1.18, 95% CI 0.76 to 1.83). The rate of compliance with the triage algorithm for cases not already en route to or at a healthcare facility when the poison control center was contacted was 87% for paroxetine IR and 89% for paroxetine CR. Conclusions: The toxicity and management of paroxetine IR and paroxetine CR ingestions reported to Texas poison control centers were similar after adjusting for differences in dosage.

Review of toxicity and trends in the use of tiagabine as reported to US poison centers from 2000 to 2012

2015 ◽  
Vol 35 (2) ◽  
pp. 109-113 ◽  
Author(s):  
HA Spiller ◽  
D Wiles ◽  
JL Russell ◽  
MJ Casavant
Keyword(s):  
Suicide Attempt ◽  
Suicide Ideation ◽  
Temporal Trends ◽  
Care Facility ◽  
Health Care Facility ◽  
High Rate ◽  
Clinical Effects ◽  
Gamma Aminobutyric Acid ◽  
Poison Centers ◽  
National Poison Data System

Background: Tiagabine is a novel antiepileptic that acts by increasing synaptic and extracellular gamma-aminobutyric acid concentrations. Information concerning overdose of tiagabine is limited. After introduction, an increasing number of off-label uses suggested that tiagabine use would increase. However in 2005 and 2008, warnings from the Food and Drug Administration (FDA) were issued on the risk of seizures in non-epileptic and increased suicide ideation. We evaluated the temporal trends associated with these two warnings as well as clinical outcomes from tiagabine overdose. Method: A retrospective review of all single substance tiagabine exposures in National Poison Data System (NPDS) from 2000 to 2012. Results: A total of 2147 patients had ingested tiagabine, with a mean of 165 year−1. This was disproportionally distributed, with a steep rise leading up to 2004 (max 559 year−1) and then a significant decline ( p < 0.05) between 2005 and 2006. The number of cases reported to NPDS mirrored the sales of tiagabine. Clinical effects were predominantly neurological, with the most commonly reported effects being drowsiness (27%), agitation (19%), confusion (12%), seizures (11%), and tachycardia (10%). In all, 758 patients (35%) showed a major or moderate medical outcome, with no deaths reported. A disproportionate share of the major outcomes was in the suicide attempt group (73%). The majority of patients (75%) were treated in a health-care facility (HCF). Conclusions: The HCF usage is likely due to high rate of symptomatic patients (59%) and the large proportion of suicide attempt cases. The frequency of tiagabine cases in NPDS mirrored pharmaceutical sales, with steep declines temporally related to the 2005 FDA warning.

An 11-year retrospective review of venlafaxine ingestion in children from the California Poison Control System

2015 ◽  
Vol 35 (7) ◽  
pp. 767-774 ◽  
Author(s):  
S Doroudgar ◽  
PJ Perry ◽  
GD Lackey ◽  
NG Veselova ◽  
HM Chuang ◽  
...  
Keyword(s):  
Health Care ◽  
Control System ◽  
Care Facility ◽  
Health Care Facility ◽  
Altered Mental Status ◽  
The United States ◽  
Poison Control ◽  
Minor Effect ◽  
Clinical Effects ◽  
Phone Calls

Venlafaxine is commonly used in the United States for approved and non-Food and Drug Administration–approved indications in adults. It is used off-label to treat children for psychiatric diagnoses. The aim of the study was to describe venlafaxine toxicities in children and to identify the venlafaxine dose per weight that correlates with toxicities. An 11-year retrospective study of venlafaxine ingestion in children was performed using the California Poison Control System (CPCS) database. Data was extracted from phone calls received by CPCS clinicians and follow-up phone calls made to assess the patient’s progress in a health-care setting. Inclusion criteria were venlafaxine ingestion cases reported to CPCS between January 2001 and December 2011, children aged 20 years and under, venlafaxine as the only ingested substance, managed in a health-care facility, and followed to a known outcome. Two hundred sixty-two cases met the study criteria. Common presentations included gastrointestinal (14.9%), altered mental status (13.7%), and tachycardia (13.4%). The majority of the cases resulted in no effect (51.5%) or minor effect (19.9%). The average estimated dose per weight was 18.3 mg/kg in all patients and 64.5 mg/kg in those experiencing moderate-to-severe adverse effects. Seizures occurred in only 4 of the 262 cases at doses ranging from 1500 to 7500 mg. Although the estimated dose per weight exceeded 10 mg/kg for the majority of the cases, only 12 cases resulted in moderate or severe outcomes. The majority of venlafaxine ingestion cases in children resulted in either no clinical effects or minor clinical effects.

Thirteen years of oxcarbazepine exposures reported to US poison centers

2016 ◽  
Vol 35 (10) ◽  
pp. 1055-1059 ◽  
Author(s):  
HA Spiller ◽  
J Strauch ◽  
SJ Essing-Spiller ◽  
G Burns
Keyword(s):  
Adult Population ◽  
Care Facility ◽  
Health Care Facility ◽  
Cardiovascular Complications ◽  
Major Effect ◽  
Clinical Effects ◽  
Electrolyte Disturbance ◽  
Generalized Seizures ◽  
Poison Centers ◽  
National Poison Data System

Objectives: Oxcarbazepine (OXC) is a 10-keto analogue of carbamazepine used in patients with partial and secondary generalized seizures. We evaluated ingestions of OXC reported to US poison centers for adverse effects from supratherapeutic doses and/or overdose. Method: Retrospective analysis of data reported to National Poison Data System from single-substance OXC ingestions between January 2000 and December 2012. Results: There were 18,867cases with a mean of 1451 exposures/year. The patients were predominantly adults with 5464 exposures in children <6 years (29%). The most commonly reported clinical effects were drowsiness ( n = 4703, 25%), vomiting ( n = 1559, 8%), tachycardia ( n = 590, 3%), agitated ( n = 342, 1.8%), hypotension ( n = 178, 0.9%), electrolyte disturbance ( n = 153, 0.8%), coma (n = 156, 0.8%), and seizures ( n = 121, 0.6%). There were 176 patients with a major effect of which 31 involved were children and 1728 (9%) patients with moderate effects of which 300 involved were children. Five deaths were reported in adults. Intentional exposure (e.g. suicide) was the reason for exposure in 68% of patients with major effects and in all fatalities. Fifty-three percent of adults and 38% of children were managed in a health-care facility (HCF). HCF utilization levels remained consistent. Discussion: Severe outcomes appear to be infrequent (<1%). Unlike other anticonvulsants OXC does not appear to be proconvulsant in overdose. Conclusion: Serious outcomes for OXC overdoses are unlikely in the pediatric patient. With only mild symptoms likely, observation at home may be appropriate for the majority of cases. In the adult population there appears to be few neurologic and cardiovascular complications even in the intentional exposure.

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